Sinonasal Inverted Papilloma: Approach to Surgery and Management

PROGRAM DESCRIPTION: Inverted papillomas (IP) are benign epithelial growths of the sinonasal tract, accounting for 0.5%–4% of sinonasal neoplasms. These tumors carry a 5%–15% risk of malignant transformation into squamous cell carcinoma (SCC). If untreated or inadequately followed, IPs can become locally destructive and recurrent. Common symptoms, including nasal obstruction, epistaxis, rhinorrhea, post-nasal drip, and acute or chronic sinusitis, often overlap with conditions like allergies, sinusitis, and reflux. Early detection and appropriate treatment are essential for effective management.

Surgical excision via endoscopic sinus surgery is the primary treatment, with complete resection and removal of the attachment site crucial to minimize recurrence. While traditional IP typically has a single attachment point, multiple centers have seen recent cases of diffuse IP, sometimes coexisting with nasal polyps, that have multiple attachment sites to the sinonasal or skull base bones. These complex cases require advanced techniques, often involving collaboration with rhinology, skull base, neurosurgery, and oculoplastics specialists.

Advances in surgical approaches, along with a deeper understanding of IP etiology and risk factors can improve management. Recent advances have occurred in surgical endoscopic approach options and our understanding of clinically relevant etiology and risk factors. Notable factors include the use of extended skull base approaches, the association of HPV and EBV with IP formation, environmental exposures, and the link between neighborhood disadvantage and IP severity.

All otolaryngologists who encounter these common sinonasal tumors must be well-versed in the epidemiology, pathophysiology, and risk factors of IP, as well as in treatment strategies and the long-term follow-up required for optimal patient outcomes.

OUTCOME OBJECTIVE 1: Discuss the pathophysiology, epidemiology, imaging findings, and clinical presentation of localized and diffuse IP with a focus on new data

OUTCOME OBJECTIVE 2: Review risk factors, associated exposures, and comorbid conditions in IP

OUTCOME OBJECTIVE 3: Use case presentations to review surgical management techniques, long-term surveillance planning, and when to consider involving other specialties

BACKGROUND STATEMENT: Inverted papillomas (IP) are benign sinonasal tumors with a 5%–15% risk of malignant transformation. Early detection and treatment are crucial to prevent recurrence. Otolaryngologists must understand IP risk factors, treatment, and surveillance for effective management.

Comprehensive Otolaryngology Track Statement : IP is a common benign tumor seen by comprehensive ENTs with a 5%–15% risk of malignant transformation to scca. Early detection, proper treatment, long-term follow-up, and coordination of care with risk reduction are crucial for effective management and recurrence prevention.